Review Article

Systematic Review of the Risk of Uterine Rupture with the Use of Amnioinfusion After Previous Cesarean Delivery

Authors: Paul Hicks, MD

Abstract

Objectives: Amnioinfusion is commonly used for the intrapartum treatment of women with pregnancy complicated by thick meconium or oligohydramnios with deep variable fetal heart rate decelerations. Its benefit in women with previous cesarean deliveries is less known. Theoretically, rapid increases in intrauterine volume would lead to a higher risk of uterine rupture.


Methods: Searches of the Cochrane Library from inception to the third quarter of 2001 and MEDLINE, 1966 to November 2001, were performed by using keywords “cesarean” and “amnioinfusion.” Search terms were expanded to maximize results. All languages were included. Review articles, editorials, and data previously published in other sites were not analyzed.


Results: Four studies were retrieved having unduplicated data describing amnioinfusion in women who were attempting a trial of labor after previous cesarean section. As the studies were of disparate types, meta-analysis was not possible.


Conclusions: The use of amnioinfusion in women with previous cesarean delivery who are undergoing a trial of labor may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.


Key Points


* Amnioinfusion is commonly used in modern obstetric practice.


* Many physicians hesitate to use it in women with a previous uterine scar.


* Review of the literature is inconclusive as to whether there is an increased risk of uterine rupture among women undergoing amnioinfusion who have had previous cesarean section.

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